title: Patient time costs attributable to healthcare use in diabetes: results from the population-based KORA survey in Germany.
abstract: OBJECTIVE
  Patient time costs have been described to be substantial; however, data are highly limited. We estimated patient time costs attributable to outpatient and inpatient care in study participants with diagnosed diabetes, previously undetected diabetes, impaired glucose regulation and normal glucose tolerance.
  
  
  METHODS
  Using data of the population-based KORA S4 study (55-74 years, random sample of n = 350), we identified participants' stage of glucose tolerance by oral glucose tolerance test. To estimate mean patient time costs per year (crude and standardized with respect to age and sex), we used data regarding time spent with ambulatory visits including travel and waiting time and with hospital stays (time valued at a 2011 net wage rate of €20.63/h). The observation period was 24 weeks and data were extrapolated to 1 year.
  
  
  RESULTS
  Eighty-nine to 97% of participants in the four groups (diagnosed diabetes, undetected diabetes, impaired glucose regulation and normal glucose tolerance.) had at least one physician contact and 4-14% at least one hospital admission during the observation period. Patient time [h/year (95% CI)] was 102.0 (33.7-254.8), 53.8 (15.0-236.7), 59.3 (25.1-146.8) and 28.6 (21.1-43.7), respectively. Age-sex standardized patient time costs per year (95% CI) were €2447.1 (804.5-6143.6), €880.4 (259.1-3606.7), €1151.6 (454.6-2957.6) and €589.2 (435.8-904.8).
  
  
  CONCLUSIONS
  Patient time costs were substantial--even higher than medication costs in the same study population. They are higher in participants with diagnosed diabetes, but also in those with undetected diabetes and impaired glucose regulation compared with those with normal glucose tolerance. Research is needed in larger populations to receive more precise and certain estimates that can be used in health economic evaluation.
authors.affiliation: Department of Public Health, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany; Institute of Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine-University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Icks
authors.forename: H
authors.initials: H
authors.lastname: Claessen
authors.forename: K
authors.initials: K
authors.lastname: Strassburger
authors.forename: R
authors.initials: R
authors.lastname: Waldeyer
authors.forename: N
authors.initials: N
authors.lastname: Chernyak
authors.forename: F
authors.initials: F
authors.lastname: Jülich
authors.forename: W
authors.initials: W
authors.lastname: Rathmann
authors.forename: B
authors.initials: B
authors.lastname: Thorand
authors.forename: C
authors.initials: C
authors.lastname: Meisinger
authors.forename: C
authors.initials: C
authors.lastname: Huth
authors.forename: I-M
authors.initials: IM
authors.lastname: Rückert
authors.forename: M
authors.initials: M
authors.lastname: Schunk
authors.forename: G
authors.initials: G
authors.lastname: Giani
authors.forename: R
authors.initials: R
authors.lastname: Holle
mesh_terms: D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011320:Primary Health Care / Q000191:economics; D013997:Time Factors